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Nakazato A, Takakura H, Do TA, Ueda N, Takeda N, Watanabe Y, Shojaku H. Efficiency of a novel middle ear pressure device for intractable definite Meniere's disease and delayed endolymphatic hydrops after certification by the public health insurance system in Japan. Acta Otolaryngol 2022; 142:388-394. [PMID: 35544580 DOI: 10.1080/00016489.2022.2059103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Middle ear pressure therapy (MEPT) is effective in treating intractable vertigo in patients with definite Meniere's disease (MD) and delayed endolymphatic hydrops (DEH) refractory to conservative treatment. A novel middle ear pressure device, the EFET01®, which requires no transtympanic ventilation tubes, was developed in Japan, approved by the Japanese Ministry of Health, Labour and Welfare, and has been used under Japanese national health insurance since September 2018. OBJECTIVES To examine short-term therapeutic effect of MEPT using the ETET01® compared with previous clinical trial results. METHODS Patients selected according to Japan Society for Equilibrium Research (JSER) guidelines underwent MEPT using the EFET01 from September 2018 to July 2021, and 44 patients were enrolled in this retrospective study. Clinical data analysed at 4 months after the start of MEPT were compared with those of the previous clinical trial for the EFET01. RESULTS MEPT using the EFET01 showed the same therapeutic efficacy as that of the previous clinical trial, i.e. improvement in the intensity and frequency of vertigo with no effect on hearing, even under JSER guidelines for proper use of MEPT. CONCLUSION MEPT using the EFET01 provided an effective treatment option for intractable vertigo in patients with definite MD and DEH.
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Affiliation(s)
- Akira Nakazato
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Hiromasa Takakura
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Tram Anh Do
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Naoko Ueda
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Noriaki Takeda
- Department of Otolaryngology, University of Tokushima School of Medicine, Tokushima, Japan
| | - Yukio Watanabe
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Hideo Shojaku
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
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Abstract
OBJECTIVES To investigate the beneficial effects and safety of intratympanic steroid installation compared with placebo in patients with Menière's disease. METHODS We performed a systematic literature search in MEDLINE and EMBASE for existing systematic reviews and individual randomized controlled trials (RCTs). Studies were included if they investigated the usage intratympanic steroids in patients aged 18 and above, with definite or probable Menière's disease. The quality of the identified existing reviews was assessed using the AMSTAR tool. The risk of bias in RCTs was assessed using the Cochrane Risk of Bias Tool and overall quality of the individual outcomes was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method. RESULTS The literature search provided four systematic reviews, from which one yielded a sufficient AMSTAR evaluation and subsequently provided three RCTs relevant for inclusion. Due to the lack of sufficient reporting of the data, quantitative synthesis was not applicable. In the qualitative synthesis for the primary outcome, the results from the RCTs showed that there was a slight indication of steroid treatment reducing the frequency of vertiginous attacks. No serious adverse events were reported. Based on the GRADE approach the quality for both findings is very low. No studies reported on the secondary outcomes. CONCLUSION The effect of intratympanic steroid treatment in Menière's disease is questionable. There is a great need for further research to sufficiently assess whether steroid treatment may be considered as a safe and effective treatment for patients with Menière's disease.
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Devantier L, Hansen AK, Mølby-Henriksen JJ, Christensen CB, Lildal T, Pedersen M, Magnusson M, Borghammer P, Ovesen T. PET Visualized Stimulation of the Vestibular Organ in Menière's Disease. Front Neurol 2020; 11:11. [PMID: 32047473 PMCID: PMC6997538 DOI: 10.3389/fneur.2020.00011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/07/2020] [Indexed: 01/05/2023] Open
Abstract
Introduction: The cortical metabolic activity in patients with Menière's disease has not been investigated. The aim of this study was to investigate the 18F-FDG cerebral uptake in Menière's patients compared to healthy controls. Method: Eight patients with right-sided Menière's disease and fourteen healthy controls underwent a video head impulse test (vHIT), test of utricular function with ocular vestibular evoked myogenic potentials (oVEMP) and three 18F-FDG-based PET examinations of the brain. Participants were seated in a self-propelled chair, injected with 18F-FDG and then exposed to 35 min of chair motion stimulation, followed by a PET scan. Two types of natural vestibular stimuli were applied, predominantly toward the right horizontal semicircular canal (angular acceleration) and right utriculus (linear acceleration). For baseline scans, participants were injected with 18F-FDG while seated without movement. Results: Analyses of baseline scans revealed decreased 18F-FDG-uptake in the medial part of Heschl's gyrus in the left hemisphere in patients with Menière's disease compared to healthy controls. During angular vestibular stimulation there was also a significantly decreased 18F-FDG uptake in the intersection between the medial part of Heschl's gyrus and the parietal operculum in the left hemisphere and bilaterally in the posterior part of insula. During linear stimulation, Menière's patients showed decreased 18F-FDG uptake in the medial part of Heschl's gyrus in the right hemisphere and also bilaterally in the posterior insula. In addition, decreased 18F-FDG uptake was seen in the thalamus during vestibular stimulation. Conclusion: Heschl's gyrus, the posterior part of insula, and thalamus have previously been shown to be core areas for processing vestibular inputs. Patients with Menière's disease solely differed from the healthy controls with lower cortical activity in these areas at baseline and during natural vestibular stimulation.
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Affiliation(s)
- Louise Devantier
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Oto-Rhino-Laryngology, Regional Hospital West Jutland, Holsterbo, Denmark
| | - Allan K Hansen
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Tina Lildal
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Oto-Rhino-Laryngology, Regional Hospital West Jutland, Holsterbo, Denmark
| | - Michael Pedersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Comparative Medicine Lab, Aarhus University, Aarhus, Denmark
| | - Måns Magnusson
- Department of Oto-Rhino-Laryngology, Lund University Hospital, Lund, Sweden
| | - Per Borghammer
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Therese Ovesen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Oto-Rhino-Laryngology, Regional Hospital West Jutland, Holsterbo, Denmark
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Devantier L, Guldfred FLA, Djurhuus BD, Händel MN, Schmidt JH, Hougaard DD, Edemann-Callesen H. Positive pressure device treatment for Menière's disease: an overview of the current evidence and a meta-analysis. Eur Arch Otorhinolaryngol 2019; 276:1263-1273. [PMID: 30809697 DOI: 10.1007/s00405-019-05359-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 02/22/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The objective was to critically assess the current evidence investigating the efficacy of using a positive pressure device in patients with definite or probable Menière's disease. METHODS We performed a systematic literature search in MEDLINE, EMBASE and PsycINFO up to February 2018. We included both systematic reviews and primary literature [randomized controlled trials (RCTs)] investigating positive pressure treatment, in patients (≥ 18 years of age), with Menière's disease. We assessed the internal validity of systematic reviews using the AMSTAR tool and risk of bias of primary studies using the Cochrane Risk of bias tool. We performed a meta-analysis for each outcome based on the identified studies. The overall certainty of evidence for the outcomes was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE). RESULTS The search for systematic reviews identified four relevant reviews. These all included the same four RCTs. An updated search identified one additional RCT. In total, five RCTs were included in the data synthesis. Our data synthesis showed no effect of positive pressure treatment on primary nor secondary outcomes. No serious adverse events were reported. The overall certainty of evidence ranged from very low to low, due to the serious risk of bias and imprecision. CONCLUSION The current available evidence does not support positive pressure device treatment in patients with Menière's disease. However, the limitations of the current literature hinder the possibility of any solid conclusion. There remains a need for randomized controlled trials of high quality to fully access the utility of this treatment.
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Affiliation(s)
- Louise Devantier
- Department of Clinical Medicine, Aarhus University, Noerrebrogade 44, building 10G, 2nd floor, 8000, Aarhus C, Denmark. .,Department of Oto-Rhino-Laryngology, Regional Hospital West Jutland, Laegaardvej 12, Holstebro, 7500, Denmark.
| | | | - Bjarki Ditlev Djurhuus
- Department of Ear, Nose, Throat and Maxillofacial Surgery, Zealand University Hospital, Lykkebaekvej 1, 4600, Koege, Denmark
| | - Mina Nicole Händel
- The Danish Health Authority, Islands Brygge 67, 2300, Copenhagen, Denmark.,The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
| | - Jesper Hvass Schmidt
- Department of ORL, Head and Neck Surgery and Audiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
| | - Dan Dupont Hougaard
- Department of Otolaryngology, Head & Neck Surgery and Audiology, Aalborg University Hospital, Havrevangen 1, 9000, Aalborg, Denmark
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Nevoux J, Barbara M, Dornhoffer J, Gibson W, Kitahara T, Darrouzet V. International consensus (ICON) on treatment of Ménière's disease. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:S29-S32. [PMID: 29338942 DOI: 10.1016/j.anorl.2017.12.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/07/2017] [Accepted: 12/12/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To present the international consensus for recommendations for Ménière's disease (MD) treatment. METHODS Based on a literature review and report of 4 experts from 4 continents, the recommendations have been presented during the 21st IFOS congress in Paris, in June 2017 and are presented in this work. RESULTS The recommendation is to change the lifestyle, to use the vestibular rehabilitation in the intercritic period and to propose psychotherapy. As a conservative medical treatment of first line, the authors recommend to use diuretics and Betahistine or local pressure therapy. When medical treatment fails, the recommendation is to use a second line treatment, which consists in the intratympanic injection of steroids. Then as a third line treatment, depending on the hearing function, could be either the endolymphatic sac surgery (when hearing is worth being preserved) or the intratympanic injection of gentamicin (with higher risks of hearing loss). The very last option is the destructive surgical treatment labyrinthectomy, associated or not to cochlear implantation or vestibular nerve section (when hearing is worth being preserved), which is the most frequent option.
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Affiliation(s)
- J Nevoux
- Department of otology and neurotology, CHU de Bicetre, AP-HP, 94270 Le Kremlin-Bicêtre, France; Saclay university, Paris-Sud Medical School, 94270 Le Kremlin-Bicêtre, France.
| | - M Barbara
- Department of otology and neurotology, Sapienza university, Rome, Italy
| | - J Dornhoffer
- Department of otolaryngology, head and neck surgery, university of Arkansas for medical sciences and Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - W Gibson
- Department of otolaryngology, head and neck surgery, university of Sidney, Australia
| | - T Kitahara
- Department of otolaryngology, Nara medical university, Japan
| | - V Darrouzet
- Department of otolaryngology, Skull Base Surgery, CHU de Bordeaux, université de Bordeaux, 33000 Bordeaux, France
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